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FOR OFFICE USE ONLY <br />R~celved by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ~n - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-794S <br /> <br />ELECTRICAL PE'RM/TAPPLICATION <br />Please complete all Sect/on& 1 through 5 <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />PERMITS ARE NON-31LANSFERABLE AND NON-REFUNDABLE AND <br />EXP IR E]F w ORK 1S NOT STARTED"' W rrltI~ 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPF. hNDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Mating Addmss <br /> <br />Signature of Su~.is~g El~tdc[an ~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Propecty Owner <br /> <br />Mailing Address <br /> <br />Phone <br /> <br />City/State/Zip <br /> <br />The installat[on is being made on prol~erly I own wh/ch is not intended for sale, <br /> <br />We will provide plan review service if you complcte Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br /> This optional plan review program does not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />A, Residential Per Unit <br /> Service Included: <br /> <br />4. FEE SCHEDULE (Complete and enter toed in Al below) <br /> <br /> ' ~ % I ~t~s Cost (=ach) Sum/ <br /> <br />1000 sq. ft. (n' lass <br />Each additional 500 ~q. ft. <br /> or portion thereof <br />Lbnited Energy <br /> <br />$85.00 4 <br /> <br /> $15.00 <br /> $20.00 <br />Each Manufd Itomc or Modular ? ~b.oo <br />Dwelling Set.ice or Feeder $40.00 2 <br /> <br />B. Services or Feeders (Does not inlcude branch circuits, see section D) <br /> <br />200 amp* or loss $50.00 2 <br />201 am~ to 400 amps $60.00 2 <br />401 am~ to 6(10 amps $100.00 2 <br />(:OI amp~ to 1000 amp~ $130.00 2 <br /> <br /> ( As required by Building Official) . <br /> <br />5. FEES <br /> Al, Enter total of fees from Sec. #4 <br /> A2. Add 5% smcharge (.0~ x A I) <br /> <br /> Subtotal <br /> <br /> B. Fmt¢~ 25% of ~.n~ Al for Plan Review <br /> (Sec. 3). if required <br /> C. Investigation Fee (ff required) <br /> D. Rcinspecfi~ Fee ($25.00) <br /> <br /> TOTALAMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />